Provider Demographics
NPI:1053529271
Name:WILKERSON, FRANCINE R (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:FRANCINE
Middle Name:R
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SW WOODLEAF CT
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-0634
Mailing Address - Country:US
Mailing Address - Phone:386-984-5262
Mailing Address - Fax:
Practice Address - Street 1:185 SW WOODLEAF CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-0634
Practice Address - Country:US
Practice Address - Phone:386-984-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8890722Medicaid